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Nutrients Sep 2019Home parenteral nutrition (HPN) has become a common therapy. There is still controversy regarding the possibility that peripherally inserted central catheters (PICCs)... (Meta-Analysis)
Meta-Analysis
Infectious Complications in Home Parenteral Nutrition: A Systematic Review and Meta-Analysis Comparing Peripherally-Inserted Central Catheters with Other Central Catheters.
BACKGROUND
Home parenteral nutrition (HPN) has become a common therapy. There is still controversy regarding the possibility that peripherally inserted central catheters (PICCs) may diminish catheter-related blood stream infection (CRBSI) rates.
METHODS
We searched the PubMed database for studies reporting the rates of CRBSI with HPN. Study selection was performed independently by three investigators. Disagreements were discussed and resolved by consensus or by arbitration by an author not involved in the search. The National Institutes of Health Quality Assessment Tools was used to assess the methodological quality of the studies. Meta-analyses were performed using MetaXL 5.3 with the quality effects model.
RESULTS
Screening of the article titles and abstracts yielded 134 full text articles for evaluation. Only three prospective studies that included appropriate data were considered for the final analysis. The relative risk of the CRBSI rate was 0.41 (0.14-1.17) for PICC vs. tunneled catheters. The relative risk of the CRBSI rate was 0.16 (0.04-0.64) for PICC vs. ports. The relative risk of the thrombosis rate was 3.16 (0.20-49.67) for PICCs vs. tunneled.
CONCLUSIONS
There is insufficient evidence to show a difference in CRBSI rates between PICCs and tunneled catheters. On the other hand, PICCs showed lower CRBSI rates than ports. There was also no difference in the rate of catheter-related thrombosis and mechanical complications.
Topics: Bacterial Infections; Catheter-Related Infections; Catheters; Humans; Parenteral Nutrition, Home
PubMed: 31487777
DOI: 10.3390/nu11092083 -
Nutrients Aug 2023Maintaining adequate nutritional status can be a challenge for patients with small bowel neuroendocrine tumours (NETs). Surgical resection could result in short bowel... (Review)
Review
INTRODUCTION
Maintaining adequate nutritional status can be a challenge for patients with small bowel neuroendocrine tumours (NETs). Surgical resection could result in short bowel syndrome (SBS), whilst without surgical resection there is a considerable risk of ischemia or developing an inoperable malignant bowel obstruction (IMBO). SBS or IMBO are forms of intestinal failure (IF) which might require treatment with home parenteral nutrition (HPN). Limited data exist regarding the use of HPN in patients with small bowel neuroendocrine tumours, and it is not frequently considered as a possible treatment.
METHODS
A systematic review was performed regarding patients with small bowel NETs and IF to report on overall survival and HPN-related complications and create awareness for this treatment.
RESULTS
Five articles regarding patients with small bowel NETs or a subgroup of patients with NETs could be identified, mainly case series with major concerns regarding bias. The studies included 60 patients (range 1-41). The overall survival time varied between 0.5 and 154 months on HPN. However, 58% of patients were alive 1 year after commencing HPN. The reported catheter-related bloodstream infection rate was 0.64-2 per 1000 catheter days.
CONCLUSION
This systematic review demonstrates the feasibility of the use of HPN in patients with NETs and IF in expert centres with a reasonable 1-year survival rate and low complication rate. Further research is necessary to compare patients with NETs and IF with and without HPN and the effect of HPN on their quality of life.
Topics: Humans; Intestinal Failure; Feasibility Studies; Quality of Life; Neuroendocrine Tumors; Parenteral Nutrition, Home
PubMed: 37686819
DOI: 10.3390/nu15173787 -
The American Journal of Clinical... Sep 2021Catheter-related bloodstream infection (CRBSI) is a life-threatening complication of parenteral nutrition. Therefore, optimal management, ideally with catheter salvage,... (Meta-Analysis)
Meta-Analysis
Comparing success rates in central venous catheter salvage for catheter-related bloodstream infections in adult patients on home parenteral nutrition: a systematic review and meta-analysis.
BACKGROUND
Catheter-related bloodstream infection (CRBSI) is a life-threatening complication of parenteral nutrition. Therefore, optimal management, ideally with catheter salvage, is required to maintain long-term venous access.
OBJECTIVES
We aimed to evaluate successful catheter salvage rates in patients on home parenteral nutrition (HPN).
METHODS
Studies were retrieved from medical databases, conference proceedings, and article reference lists. Data were collected relating to clinical outcomes of 3 treatments: systemic antibiotics, antimicrobial lock therapy (ALT), and catheter exchange. ORs and 95% CIs were calculated from a mixed logistic effects model.
RESULTS
From 10,036 identified publications, 28 met the inclusion criteria (22 cohort studies, 5 case-control studies, and 1 randomized clinical trial), resulting in a total of 4911 CRBSIs. To achieve successful catheter salvage, the addition of an antimicrobial lock solution was superior to systemic antibiotics alone (OR: 1.75; 95% CI: 1.21, 2.53; P = 0.003). Recurrence of infection was less common in studies that used ALT than in those that used systemic antibiotics alone (OR: 0.26; 95% CI: 0.11, 0.61; P = 0.002). The catheter exchange group was excluded from multilevel regression analysis because only 1 included study applied this treatment. Successful salvage rates were highest for coagulase-negative staphylococci, followed by Gram-negative rods and Staphylococcus aureus .
CONCLUSIONS
The addition of an antimicrobial lock solution seems beneficial for successful catheter salvage in HPN-dependent patients with a CRBSI. Future prospective randomized studies should identify the most effective and pathogen-specific strategy.This review was registered at www.crd.york.ac.uk/PROSPERO as CRD42018102959.
Topics: Anti-Bacterial Agents; Catheter-Related Infections; Central Venous Catheters; Humans; Parenteral Nutrition, Home
PubMed: 34038951
DOI: 10.1093/ajcn/nqab164 -
Critical Care (London, England) Apr 2014The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The... (Review)
Review
INTRODUCTION
The potential benefit of parenteral glutamine (GLN) supplementation has been one of the most commonly studied nutritional interventions in the critical care setting. The aim of this systematic review was to incorporate recent trials of traditional parenteral GLN supplementation in critical illness with previously existing data.
METHODS
All randomized controlled trials of parenterally administered GLN in critically ill patients conducted from 1997 to 2013 were identified. Studies of enteral GLN only or combined enteral/parenteral GLN were excluded. Methodological quality of studies was scored and data was abstracted by independent reviewers.
RESULTS
A total of 26 studies involving 2,484 patients examining only parenteral GLN supplementation of nutrition support were identified in ICU patients. Parenteral GLN supplementation was associated with a trend towards a reduction of overall mortality (relative risk (RR) 0.88, 95% confidence interval (CI) 0.75, 1.03, P = 0.10) and a significant reduction in hospital mortality (RR 0.68, 95% CI 0.51, 0.90, P = 0.008). In addition, parenteral GLN was associated with a strong trend towards a reduction in infectious complications (RR 0.86, 95% CI 0.73, 1.02, P = 0.09) and ICU length of stay (LOS) (WMD -1.91, (95% CI -4.10, 0.28, P = 0.09) and significant reduction in hospital LOS (WMD -2.56, 95% CI -4.71, -0.42, P = 0.02). In the subset of studies examining patients receiving parenteral nutrition (PN), parenteral GLN supplementation was associated with a trend towards reduced overall mortality (RR 0.84, 95% CI 0.71, 1.01, P = 0.07).
CONCLUSIONS
Parenteral GLN supplementation given in conjunction with nutrition support continues to be associated with a significant reduction in hospital mortality and hospital LOS. Parenteral GLN supplementation as a component of nutrition support should continue to be considered to improve outcomes in critically ill patients.
Topics: Critical Care; Glutamine; Hospital Mortality; Humans; Infections; Length of Stay; Mortality; Parenteral Nutrition; Treatment Outcome
PubMed: 24745648
DOI: 10.1186/cc13836 -
Respiratory Care Nov 2017Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition,... (Review)
Review
Parenteral nutrition is indicated in amyotrophic lateral sclerosis (ALS) when dysphagia, loss of appetite, and difficulty protecting the airways cause malnutrition, severe weight loss, dehydration, and increased risk of aspiration pneumonia. The aim of this review is to compare percutaneous endoscopic gastrostomy (PEG), radiologically inserted G-tube (RIG), and percutaneous radiologic gastrostomy (PRG) in patients with ALS, performed with or without noninvasive ventilation (NIV). We searched PubMed, MEDLINE, EMBASE, the Cochrane Central Register of Controlled Trials (CENTRAL), the EBSCO Online Research Database, and Scopus up to December 2015. A priori selection included all randomized controlled trials (RCTs), quasi-randomized trials, and prospective and retrospective studies. The primary outcome was 30-d survival. We found no RCTs or quasi-RCTs. Seven studies about the implementation of the PEG/RIG procedure during the use of NIV and 5 studies without NIV were included. In another study of 59 subjects undergoing open gastrostomy, all with vital capacity < 30% of normal, 18 of whom were dependent on continuous NIV at full ventilatory support settings, there were no respiratory complications. Thus, the use of NIV during the implementation of these procedures, especially when used at full ventilatory support settings of pressure preset 18-25 cm HO, can support alveolar ventilation before, during, and after the procedures and prevent respiratory complications. The procedures investigated appear equivalent, but the methodological quality of the studies could be improved. Possible benefits with regard to nutrition parameters, quality of life, and psychological features need to be further investigated.
Topics: Amyotrophic Lateral Sclerosis; Enteral Nutrition; Gastrostomy; Humans; Intubation, Gastrointestinal; Noninvasive Ventilation; Treatment Outcome; Vital Capacity
PubMed: 28807987
DOI: 10.4187/respcare.05031 -
The Cochrane Database of Systematic... Oct 2006Head injury increases the body's metabolic responses, and therefore nutritional demands. Provision of an adequate supply of nutrients is associated with improved... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Head injury increases the body's metabolic responses, and therefore nutritional demands. Provision of an adequate supply of nutrients is associated with improved outcome. The best route for administering nutrition (parenterally (TPN) or enterally (EN)), and the best timing of administration (for example, early versus late) of nutrients needs to be established.
OBJECTIVES
To quantify the effect on mortality and morbidity of alternative strategies of providing nutritional support following head injury.
SEARCH STRATEGY
Trials were identified by computerised searches of the Cochrane Injuries Group specialised register, Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, National Research Register, Web of Science and other electronic trials registers. Reference lists of trials and review articles were checked. The searches were last updated in July 2006.
SELECTION CRITERIA
Randomised controlled trials of timing or route of nutritional support following acute traumatic brain injury.
DATA COLLECTION AND ANALYSIS
Two authors independently abstracted data and assessed trial quality. Information was collected on death, disability, and incidence of infection. If trial quality was unclear, or if there were missing outcome data, trialists were contacted in an attempt to get further information.
MAIN RESULTS
A total of 11 trials were included. Seven trials addressed the timing of support (early versus delayed), data on mortality were obtained for all seven trials (284 participants). The relative risk (RR) for death with early nutritional support was 0.67 (95% CI 0.41 to 1.07). Data on disability were available for three trials. The RR for death or disability at the end of follow-up was 0.75 (95% CI 0.50 to 1.11). Seven trials compared parenteral versus enteral nutrition. Because early support often involves parenteral nutrition, three of the trials are also included in the previous analyses. Five trials (207 participants) reported mortality. The RR for mortality at the end of follow-up period was 0.66 (0.41 to 1.07). Two trials provided data on death and disability. The RR was 0.69 (95% Cl 0.40 to 1.19). One trial compared gastric versus jejunal enteral nutrition, there were no deaths and the RR was not estimable.
AUTHORS' CONCLUSIONS
This review suggests that early feeding may be associated with a trend towards better outcomes in terms of survival and disability. Further trials are required. These trials should report not only nutritional outcomes but also the effect on death and disability.
Topics: Craniocerebral Trauma; Enteral Nutrition; Humans; Nutritional Support; Parenteral Nutrition; Randomized Controlled Trials as Topic; Time Factors; Treatment Outcome
PubMed: 17054137
DOI: 10.1002/14651858.CD001530.pub2 -
Biology of Blood and Marrow... Aug 2019Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can... (Meta-Analysis)
Meta-Analysis
Nutritional and Post-Transplantation Outcomes of Enteral versus Parenteral Nutrition in Pediatric Hematopoietic Stem Cell Transplantation: A Systematic Review of Randomized and Nonrandomized Studies.
Hematopoietic stem cell transplantation (HSCT) involves the administration of chemotherapy followed by the infusion of donor stem cells. After treatment, children can consequently experience nausea, vomiting, diarrhea, anorexia, and mucositis, which negatively impact oral intake, leading to rapid deterioration in nutritional status and risk of malnutrition. Nutrition support therefore becomes necessary to circumvent these adverse effects. This has traditionally been provided via parenteral nutrition (PN), but pediatric evidence is increasingly advocating enteral nutrition (EN) as a preferential alternative. The objective of this review is to determine the efficacy of any forms of EN versus PN provided during admission to children aged ≤ 18 years undergoing HSCT. Primary outcomes considered efficacy in relation to various nutritional parameters, and secondary outcomes included a range of post-transplantation parameters. Data sources included English and non-English articles from the start date of MEDLINE, EMBASE, AMED, CINAHL and Cochrane Controlled Trials register, up to July 2018. Key journals were also hand searched, reference lists scanned, clinical experts contacted, and gray literature searched using EThOS and Open Grey. Randomized and observational studies comparing any forms of EN versus PN in children aged ≤ 18 years undergoing HSCT investigating nutritional or post-transplantation outcomes were eligible. Data were extracted from included studies using a custom extraction form that had previously been piloted. Because included studies were observational, risk of bias was assessed using Risk of Bias in Non-randomised Studies of Interventions. Because only a small number of heterogenous studies reporting a wide range of differently defined outcomes were included, meta-analyses were not performed and data were presented in narrative form. Conflicting results in favor of either method of nutrition support or no difference between methods were seen for duration of interventions, nutritional intakes, biochemical and anthropometric changes, mortality, infections, length of admission, and neutrophil engraftment. EN may provide favorable benefits over PN regarding acute graft-versus-host-disease (aGVHD) and platelet engraftment. A paucity of studies was found investigating the question posed by this review. Included studies were clinically heterogenous regarding populations, interventions, and outcomes, at moderate to serious risk of bias due to the absence of randomization, confounding parameters, statistical control, retrospective designs, and participant selection. Some studies were more than 15 years old. Despite the limited number and poor quality of identified studies, results support the growing body of pediatric evidence that EN is feasible during HSCT. Similar differences regarding many nutritional and post-transplantation outcomes were seen in both forms of nutrition support, but EN could provide benefits above PN including reduced incidence of aGVHD and faster platelet engraftment.
Topics: Acute Disease; Adolescent; Child; Child, Preschool; Enteral Nutrition; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Infant; Male; Observational Studies as Topic; Parenteral Nutrition; Randomized Controlled Trials as Topic
PubMed: 30826462
DOI: 10.1016/j.bbmt.2019.02.023 -
Clinical Nutrition (Edinburgh, Scotland) Apr 2013Glutamine supplementation has been associated with reduced mortality, infections and hospital length of stay in critically ill patients and patients undergoing major... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND & AIMS
Glutamine supplementation has been associated with reduced mortality, infections and hospital length of stay in critically ill patients and patients undergoing major surgery. We carried out a meta-analysis to examine randomized clinical trial (RCT)-based evidence of these effects.
METHODS
Based on a systematic database search, RCTs published since 1990 were included if they evaluated the effect of parenteral glutamine supplementation against a background of parenteral nutrition. Enteral (tube) feeding in a proportion of patients was allowable. Information on RCT methodology, quality and outcomes was extracted. Random effects meta-analysis followed the DerSimonian-Laird approach.
RESULTS
Forty RCTs were eligible for meta-analysis. Parenteral glutamine supplementation was associated with a non-significant 11% reduction in short-term mortality (RR = 0.89; 95% CI, 0.77-1.04). Infections were significantly reduced (RR = 0.83; 95% CI, 0.72-0.95) and length of stay was 2.35 days shorter (95% CI, -3.68 to -1.02) in the glutamine arms. Meta-analysis results were strongly influenced by one recent trial. An element of publication bias could not be excluded.
CONCLUSION
Parenteral glutamine supplementation in severely ill patients may reduce infections, length of stay and mortality, but substantial uncertainty remains. Unlike previous meta-analyses, we could not demonstrate a significant reduction in mortality.
Topics: Critical Illness; Dietary Supplements; Glutamine; Humans; Length of Stay; Parenteral Nutrition; Randomized Controlled Trials as Topic
PubMed: 23196117
DOI: 10.1016/j.clnu.2012.11.003 -
The Cochrane Database of Systematic... Apr 2014Many palliative care patients have a reduced oral intake during their illness. The management of this can include the provision of medically assisted nutrition with the... (Review)
Review
BACKGROUND
Many palliative care patients have a reduced oral intake during their illness. The management of this can include the provision of medically assisted nutrition with the aim of prolonging the length of life of a patient, improving their quality of life, or both. This is an updated version of the original Cochrane review published in Issue 4, 2008.
OBJECTIVES
To determine the effect of medically assisted nutrition on the quality and length of life of palliative care patients.
SEARCH METHODS
We identified studies from searching Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, CINAHL, CANCERLIT, Caresearch, Dissertation abstracts, SCIENCE CITATION INDEX and the reference lists of all eligible trials, key textbooks and previous systematic reviews. The date of the latest search was 26 March 2014.
SELECTION CRITERIA
All relevant randomised controlled trials (RCTs) or prospective controlled trials (if no RCTs were found).
DATA COLLECTION AND ANALYSIS
We found no RCTs or prospectively controlled trials that met the inclusion criteria.
MAIN RESULTS
The original review identified four prospective non-controlled trials and the updated search in 2014 identified one more (plus an updated version of a Cochrane review on enteral feeding in motor neuron disease). There were five prospective non-controlled trials (including one qualitative study) that studied medically assisted nutrition in palliative care participants, and one Cochrane systematic review (on motor neuron disease that found no RCTs), but no RCTs or prospective controlled studies.
AUTHORS' CONCLUSIONS
Since the last version of this review, we found no new studies. There are insufficient good-quality trials to make any recommendations for practice with regards to the use of medically assisted nutrition in palliative care patients.
Topics: Adult; Enteral Nutrition; Humans; Longevity; Palliative Care; Parenteral Nutrition; Quality of Life
PubMed: 24760679
DOI: 10.1002/14651858.CD006274.pub3 -
Nutricion Hospitalaria 2012Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to... (Meta-Analysis)
Meta-Analysis Review
Malnutrition in hospitals is of great concern in patients with cancer. This malnutrition in cancer leads to higher risk of complications, and worse response to treatments and outcomes. Parenteral nutrition (PN) in cancer is controversial due to the heterogeneous results found in scientific literature. This is the reason why the evaluation of adverse events of PN, its incidence and severity, is crucial when prescribing PN in cancer patients. This evaluation of adverse events of PN is the aim of the present systematic review of the randomized clinical trials (RCT) written in any language found in several databases. From the 74 articles found in our search, only 13 RCT (18 different types of cancer) met the criteria to be selected for the systematic review. These RCT included 669 patients receiving central PN in whom 225 adverse events (33.63%) of PN were described, and 92 patients with peripheral PN, with 54 adverse events (58.70%). There were no adverse events in a control group of 47 patients receiving parenteral fluids. We conclude that scientific literature is very heterogeneous and evaluate complications of parenteral nutrition only as a secondary aim. We think necessary that further research do define complications of parenteral nutrition homogeneously and study them as a main objective.
Topics: Adult; Aged; Female; Humans; Inpatients; Male; Malnutrition; Middle Aged; Neoplasms; Parenteral Nutrition; Parenteral Nutrition Solutions; Randomized Controlled Trials as Topic
PubMed: 22732962
DOI: 10.1590/S0212-16112012000200010